Understanding Dizziness: Causes, Symptoms, and Solutions with Taylor Goldberg

Michelle Shapiro [00:03:40]:
You know, I've been a bit indulgent this season of the podcast because I've really brought practitioners on who are talking about things that are so near and dear to the experience of my clients, the experience of my friends, my family members, myself, and I don't think there's any symptom more worthy of discussion and unpacking than dizziness. I have seen so many clients go through the experience of going from practitioner to practitioner with this symptom and often getting results only if the dizziness they're experiencing is vertigo, whereby a lot of clients that I work with who might have mcas pots hypermobility, they actually don't have vertigo and so they kind of are left out of this equation. Dizziness can feel so scary and so frustrating and so endless that I was driven to make this episode and make this episode quickly once I knew that we had enough of a solution based conversation to have for all of you. So I am really excited to have this conversation. I had to bring back the amazing Doctor Taylor Goldberg, who is a virtual hypermobility chiropractor. And I'll tell you a little bit more about Taylor. If you didn't hear her episode last season, it was incredible and I really recommend checking that out as well. Taylor is a chiropractor turned hypermobility coach.

Michelle Shapiro [00:05:08]:
Having personally experienced hypermobility and discovering effective solutions for herself, she is now committed to empowering fellow clinicians with the knowledge and skills necessary to deliver the same level of care to individuals with hypermobility. And I just thought this was the cutest, sweetest thing. When I asked Taylor on I have this form that I have guests fill out and I say, how would you like me to announce you? And she wrote Doctor Taylor Goldberg, DC. But you can just call me Taylor. And I think that really sums up Taylor as a person. She has all the knowledge in the world, but also the empathy, the human part of being a practitioner that I just love so much about her. She's helped me with my personal health journey. She's helped so many of our clients.

Michelle Shapiro [00:05:50]:
And I can't wait for you to hear this episode with her, especially if you're someone who's been experiencing dizziness. Taylor is also a huge part of the highly sensitive body hub where she talks about dizziness and she talks about other symptoms from the chiropractic and training standpoint. So check out the highly sensitive body hub if you haven't yet, and the link to join is below. I can't wait for you to have this episode. This is the episode on dizziness that I needed when I was dizzy for years straight. And now I'm so happy to bring it to you. Enjoy. I am so excited for this episode for a couple reasons.

Michelle Shapiro [00:06:31]:
One of them is, again, an excuse I have to sit down with you. But also, the topic we're talking about today is very near and dear to both of us, to our clients, and I think to a lot of people who have been unable to find answers to this one very specific symptom, which is dizziness. Dizziness, for me, I will tell you on a very personal note, is my least favorite symptom I could ever have. There's something about feeling dizzy, feeling vertigo, symptoms that feels so unyielding. And it also feels like I don't think there's anything I can do when this happens. It feels like I just have to wait it out. And I know for that reason, it can also feel extremely triggering for people from an anxiety perspective. So I am extra excited for you to be talking about this today.

Meet Taylor Goldberg

Michelle Shapiro [00:07:16]:
And welcome back, Taylor.

Taylor Goldberg [00:07:17]:
Thank you. So you're not sick of me yet?

Michelle Shapiro [00:07:20]:
Never. So we're going to talk about dizziness from a couple different perspectives. I think, again, when people hear dizziness, they think, I don't know why this is happening. It's random. And often when they go to doctors offices, it feels like the feedback they're getting is, this is random. Taylor, you're going to talk to us today about how dizziness shows up from a proprioception issue, a vision issue, inner ear issue, musculoskeletal issue. And actually, are you going to tell us that there is hope when it comes to dizziness?

Taylor Goldberg [00:07:49]:
Yeah, there is a lot of hope. And I think you nailed it right on the head. The scariest part about dizziness is how uncontrollable it feels. It's also, in my opinion, a debilitating symptom. You can't really go about your normal day, your normal activity. You can't really push through dizziness in the same way you can maybe push through some muscle aches and pains in that realm, when you're busy, you can't. Life doesn't feel normal. You can't go about your day to day life as you usually do.

Taylor Goldberg [00:08:18]:
And that is really, really scary. I think another big issue with dizziness is that a lot of providers, let's say, because dizziness can get scary to the point where we end up in the ER or urgent care, because it feels so out of our control, the only thing they do is say it's vertigo or it's anxiety. Those are the only two real options, and that's not true. There's a lot of other causes of dizziness. There's also really easy ways to tell if it's vertigo or if it's not vertigo, which we're going to talk about today, that I think if any clinicians are watching this, you should just be asking a couple deeper questions, because if it's not vertigo and you are doing the Epley maneuver, which we're going to define all this, but you're doing the Epley maneuver and it's not vertigo that's going to make your patient worse, and we don't want to make you worse when you're already feeling dizzy.

Michelle Shapiro [00:09:08]:
I think when we take dizziness from this big, scary, ambiguous thing into understanding those root causes and breaking it down into this is potentially why. This is potentially why. And here's things you can do. It takes a lot of the fear out of it. However, the symptom itself, we know, is uncomfortable. It's very uncomfortable, and it feels, from an anxiety perspective, that depersonalization feeling. So when we're talking about dizziness, Taylor, are we talking about, in this episode, vertigo, are we differentiating different types of dizziness and experiences someone can have? And can you describe what the symptoms of those types of dizziness might be?

Are there different types of dizziness? What would someone experience and what are the symptoms?

Taylor Goldberg [00:09:46]:
Yeah. So there's two main groups when it comes to dizziness. There's peripheral and there's central. Peripheral means it is coming from your vestibular system. There's something going on in your vestibular system, which means your ear, your inner ear. This is where vertigo comes in. BPPD, if you've heard of that. And the key symptom for this is the room is spinning.

Taylor Goldberg [00:10:09]:
That is the question your doctors should be asking, and you should be asking yourself, is the room spinning? Am I spinning? Are things spinning? That is different than central, which is your brain. And that dizziness doesn't feel like spinning. Spinning. That's the dizziness we hear about all the time in our population. That fuzzy, staticky, tv type dizziness, where you just feel almost drunk, is how I've had clients describe it to me. That is not peripheral vertigo. That is not coming from your inner ear. And it's really important we differentiate the two because the treatments are completely, completely different.

Taylor Goldberg [00:10:49]:
And so when we're talking about our system as human beings, there's three main things that control our balance. Our vision, our eyes, our proprioception, which is, where is our body in space. And we have proprioceptive receptors throughout our connective tissue, throughout our body, in our muscles, in our ligaments, tendons, and then our inner ear or our vestibular system in itself when we have peripheral vertigo. So our inner ear, the message is not getting to the brain. So we turn our head to the right, and our brain doesn't get that message, or it thinks that we are turning to the left. There's a bunch of different things that can go on that is different than central, which is your brain gets the information, but it doesn't know how to process it. So your ear said, hey, she turned her head to the right, and your brain's like, oh, there's a bird outside. Like, it didn't hear it, it didn't know.

Taylor Goldberg [00:11:45]:
And the symptoms are very, very different in our specific population, which I assume we're going to talk the most about today, is one of the main reasons for central vertigo can be a lack of blood flow to the brain and to the heart, which is what we normally see in most types of dysautonomia. Now, I want to be clear. Dysautonomia is an umbrella term. There are 30 types known right now, probably more of dysautonomia. Pots is only one type of dysautonomia, of 30 of 30 pots. And all the dysautonomia types have a lot of similarities, but they are not the same. And there are different differentiating symptoms that make pots specific, as well as different treatments that are only going to work and help for pots that aren't going to help for the other types of dysautonomia. And the opposite is true, too.

Taylor Goldberg [00:12:40]:
We can generalize some treatments, like nervous system regulation is going to be good for anybody with dysautonomia. But if you don't have pots, there are certain medications, there are certain cardiac rehab stuff that we're not going to want to do. Now, when it comes to the dizziness, this is a common general theme in most types of dysautonomia, where it is caused by gravity, not being our friend, pooling our blood to our feet, not getting it up to our head enough. And sometimes that can lead to dizziness, that can lead to heart palpitations, that can lead to a whole slur of different symptoms. The other thing, there's a lot of things that can cause the central vertigo, but one of the others that's mainly in our population is upper cervical instability, which is when top of your neck. So your skull, your first vertebra and or your second vertebra, we're kind of lumping them all together now, is unstable, and it can get to the point where those vertebra move, which is really scary and can hit your brain stem, as you can imagine, that's going to lead to dizziness, that's going to lead to your brain not being able to interpret information very well.

Michelle Shapiro [00:13:49]:
So if it's cerebral blood flow issues, let's call it, and you're having, let's say a form of dysautonomia, and we'll probably refer to pots, because even though we know there's 30 forms, we'll refer to pots here. If it's a pots like symptom and your blood flow is dropping to your feet and you get that dizziness feeling in a hot shower or after standing too long, the dizziness is quite literally coming from the fact that your brain has a smaller amount of blood flow going to it, and it's a warning sign, basically, from your brain saying, this is happening. So let's talk about also in relation to all this, you use these terms that are really, really important when it comes to dizziness, which is proprioception. Tell us what proprioception is.

What is proprioception and how could it become altered?

Taylor Goldberg [00:14:29]:
Yeah, so proprioception is, where is your body in space? What happens when we move our arm is we have receptors in our nervous system tells our brain, she just moved her arm. Sometimes that interception can be slower or not happen at all, and your brain is like, oh, she just moved her arm. I didn't know that. This can also happen with our legs when we're walking. That can make us feel dizzy, or it can make us not be able to walk in a straight line and we appear dizzy, which I think happens a lot in hypermobility. I know personally, I get told, I don't know how to walk in a straight line all of the time. But also that might make you feel dizzy, even if you are not actually, by definition, dizzy, because you are not able to walk in a straight line, that makes you feel out of sorts, that makes you feel out of control. That would be due to a lack of proprioception.

Michelle Shapiro [00:15:25]:
Tell me, also, when it comes to proprioception, why would our proprioception become altered at some point? What would make us not understand where our body's moving in space and how that relates to the rest of our body?

Taylor Goldberg [00:15:37]:
Yeah. So the honest answer, we don't always know why these things happen. There has not been a specific paper defining why this might happen. But there are a lot of hypotheses, especially in the hypermobile population. The leading hypothesis in the hypermobile population is that we either lack proprioceptive receptors due to the laxity in our connective tissue, so there's not enough for that information to get to our brain, or it is a lack of blood flow, a lack of processing, a lack of something in our actual brain that is not computing that information correctly. So there is a lot of different hypothesis on why this might be happening. We don't fully understand why, but we definitely know it is a very, very common theme in hypermobile bodies.

Michelle Shapiro [00:16:29]:
Can that be worked on? Can we work on our proprioception?

Taylor Goldberg [00:16:33]:
Yes. So that's my favorite thing about proprioception. One, it's so easy to work on. You can do it in bed, you can do it sitting up, you can do it lying down, you can do it. It is one of the most accessible things anybody can work on. Whether you are bed bound or you are not, you can work on this and it can start really, really small and it can go a really, really long way. And so you can start with very, very simple, what I call toe yoga. If you just look that up on YouTube, you'll find some things and start there.

Taylor Goldberg [00:17:04]:
You can start with just when you're brushing your teeth, standing on one leg. Start with closing your eyes when you're brushing your teeth. Little tiny things can go a really long way when it comes to proprioception. You don't have to be standing on a bozu ball and juggling and lifting 500 pounds to increase your proprioception. It can start very, very small and it can go a really, really long way.

Michelle Shapiro [00:17:27]:
So what you're describing is that something happens in your brain when you do two different things at the same time. So when you're standing on 1ft and you're brushing your teeth. Basically, the fact that you're using balance and also focusing on a task, does it activate proprioceptors, which are like, are they nerve centers? Is that how you would describe proprioceptors?

Taylor Goldberg [00:17:46]:
Yeah. So, like, kind of how in nutrition, like, enzymes have their little receptors. Think of proprioceptive receptors like those, except it's for nerves that go to the brain. And so there are some things that make our proprioceptive system more active, and that's actually taking away another system. So if we take away our eyesight, that increases our proprioception. If we take away our hearing, that increases our proprioception. If we do dual task movements like we were just describing, that can increase our proprioception. Those are the three main starting points for increasing our proprioception.

Taylor Goldberg [00:18:23]:
That can go a really, really long way. It used to be thought that we had to stand on bozu balls and all of this stuff, and I actually used to be in that camp a couple years ago, and we realized it's not supposed to be that complicated.

Michelle Shapiro [00:18:37]:
Camps are going on in the chiropractic hypermobility community. You're like, oh, you know, the standing on the Bozu bowls proprioception camp? I'm like, no, Taylor, I've never heard of it. Okay.

Taylor Goldberg [00:18:46]:
Hey, you have your own camps in nutrition.

Michelle Shapiro [00:18:48]:
Okay. We sure do. That's a good way of visualizing for people to explain it, too, that it's like these receptors, and there's things you can do to activate those receptors. And when you do, ultimately, the goal is not only for you to have less dizziness as a very long term result of that, but really, it sounds like just also creating balance within your body and understanding within what? What's my body doing kind of, and connecting the different parts of the body a little bit better.

Taylor Goldberg [00:19:16]:
Yeah. And it's also, in my opinion, about control. As humans, that's all we ever want. And don't get me wrong, part of being a human is learning to let go of control, and that's one of the most uncomfortable things for a lot of people. But if we can add a little bit more control to our life, I think we should. And if we can increase our proprioception and we're able to walk in a straight line and we're not rolling our ankles all of the time, that's going to make us feel more confident. It's going to make us feel more in control, and that, in turn, can make us feel better about ourselves, including dizziness and a lot of other symptoms.

How does improvement of our proprioception affect our nerves?

Michelle Shapiro [00:19:49]:
If we improve proprioception, which means we're affecting nerve activity, does that also mean that you might be influencing, like, nerves that control other parts of your body in ways of, like, where blood flow is going and ways of like, what muscles are being fired? Or are these nerves very specific to orienting yourself in space? That's a complicated question.

Taylor Goldberg [00:20:10]:
Yeah, so they are very specific to orienting yourself in space. But with that being said, neuroplasticity is one of the coolest things. We get the ability to change our brain pathways. We get the ability to change how our nervous system fires and how it responds and how it interacts with us. And I think if we change it in one realm of our body, it can cascade into all realms of our body. Now, I'm not going to say by working on proprioception you're going to get more blood flow to your brain because that just wouldn't be true. But I think that if we work on proprioception, we feel more confident we're able to move more confidently. That's going to get more blood back to our brain into the rest of our body.

Taylor Goldberg [00:20:51]:
That's going to allow more muscles to, because we're able to use them more. So inadvertently, I would say potentially directly. Love it.

Michelle Shapiro [00:22:52]:
So really also, the question is, what affects one area of our nervous system does not affect necessarily every area of our nervous system. However, whatever affects our brain does affect every area of our nervous system in some ways. And really when we look at these conditions, like pots and all forms of autonomy, these are all dysfunctions of the autonomic nervous system, right? These are nervous system based conditions, syndromes. So it's really interesting because we think that these are conditions of the heart or we think that these are conditions of something else, but these are really conditions of our nervous system specifically. So anything you do that makes your nervous system feel safer, anything that makes your body feel more cohesive within space, can have that indirect feedback to I don't have the dizziness symptom now. I'm having less anxiety because I don't have to deal with the symptom as much. So it's indirect. Let's talk about the vision piece of things.

Explain how our vision system and occipital lobe all relate back to this dizziness piece. And why does this all happen in pots or dysautonomia?

Michelle Shapiro [00:23:43]:

With my clients who have pots, I noticed that they have a lot of visual issues. They can get visual snow, which can kind of feel like dizziness because dizziness can also feel like kind of feeling where you're just like a little brain foggy or a little bit off, but you can't even really define it. I also have clients with pots who feel like there are blocks or like blobby blocks in your head. And when you move your head one way, it feels like, and you feel like whooshing almost going on in your head, and there's this heaviness. And that usually accompanies some visual strain, some eye issues. Talk to us about how our vision system and occipital lobe all relate back to this dizziness piece. And why does this all happen in pots or dysautonomia?

Taylor Goldberg [00:24:26]:
Yes. So our vision system, if you will, or ocular system is a part of our balance system. The thing about our vision that I want everybody to know, it's very connected to our neck, our suboccipital muscles, which are the muscles right at the back of the skull, which a lot of people in this population usually get headaches in that area or feel tension in that area. Are directly connected to our eyes. When we move our eyes side to side, we should actually feel activation in our suboccipital muscles. The other thing is that our eye nerves come from our brain. They're part of our cranial nerves. And all of this is going to impact our ability to feel balanced and be upright.

Taylor Goldberg [00:25:12]:
And so when it comes to pots, and before we even get to pots specifically, there is a lot of things in this population that mimic symptom overlap. Upper cervical instability is going to feel very similar to visual snow and to that head rocking, nodding movement. A CSF leak could potentially also feel very similar to this. Intracranial hypertension can also feel very similar to this. So I guess what I'm trying to say is, it might not just be pots. It might be. There might be other things at play. And that's really when practitioners and clinicians need to get deeper and ask deeper questions.

Taylor Goldberg [00:25:52]:
Is this dizziness happening when you're moving your head, or is it happening when you're going from sitting to that? One simple question can go so far. If you don't get any dizziness, no symptoms from moving your head, but you get dizziness from going from standing to sitting, it's probably orthostatic in nature. It's probably dysautonomia.

Michelle Shapiro [00:26:12]:
It's more of a. More of a potential blood flow piece as opposed to a cranial nerve piece. Also, you even doing that to show what happens in your head goes side to side just made me dizzy, and I'm laughing because I'm not even the one doing it. But people can also have both sources. That's why it's so important to start writing when we have dizziness. Taylor. And, you know, this personal experience, client experience, it is so alarming and so frightening. I think that we think it's this huge blob of, like, this scary thing.

Michelle Shapiro [00:26:45]:
This is my life. This is forever. We're kind of told also in the medical, I guess, like society or culture, whatever, that dizziness is permanent, and dizziness is something that, like, is just your brain and too bad. And unless it's vertigo and you can get a vertigo medication, there's just not that many options for people. People will try, like, acupuncture. They're like, maybe it's a migraine. So I'm taking migraine medications. But I think people really feel like, again, this such ambiguity around it.

Michelle Shapiro [00:27:13]:
So I think isolating your own symptoms, if you're listening and just saying, you know what, it is worse when I move my head like that. Or it is worse when I get up from sitting to standing, then you can start to see little strategies or little kind of things that you can notice based on that. So that's what I would tell people to do kind of first is try to identify is this vertigo? And that would be through a practitioner, or is this, if I'm having dizziness, where are my symptoms mostly coming from? Because that'll also let you know if you do need a practitioner, what type of practitioner you're going to want to go to? Because if it's more of a situation where it's going from sitting to standing, you're going to want to go to someone who is probably more of a, maybe a dysautonomia specialist or someone who does matters of blood flow in the heart. Interventional cardiologist, if you want that support versus if your dizziness is going when your head's moving left to right, you might need to get x rayed or scanned, maybe in a PT's office. A cairo or someone who specializes in hypermobility potentially would be really helpful.

Three questions to ask yourself when you experience dizziness:

Taylor Goldberg [00:28:09]:
Yeah. So just to summarize everything, because I know it can be kind of confusing, the three questions that can be a good starting point to ask yourself. When I feel dizzy, is it the room spinning or is it more of a static, weird feeling in my head? If it's the room is spinning or you are spinning, that is more of a peripheral vertigo, and pretty much any practitioner can help with that. You can also look up Dix hall pike maneuver as well as the epley's maneuver. And if that helps, that is more confirmation that this is peripheral vertigo, which is extremely unpleasant and uncomfortable and scary. But luckily, there is a lot we can do for that, and it is very non invasive and usually quick, too, in comparison. If it's not the room spinning and it is the next question, ask yourself, is this happening when I'm moving my neck? Is this happening when I'm going from sitting to standing? And based off of those answers, and it might be both, because two things can be true at the same time, then finding somebody who specializes in upper cervical instability and or dysautonomia, usually a neurologist, every now and then you will get a good cardiologist as well. Or vestibular pts can help with this.

Taylor Goldberg [00:29:24]:
Functional neurologist can help with this. Chiropractors that specialize in this can help with this. So there's a lot of people that can help with this specifically. And luckily for both of these, the treatments and the management options are pretty non invasive. So I think one thing about upper cervical instability that gets scary and confusing is it seems like surgery is first line option. Yeah, it's not. 5% of everybody with upper cervical instability are surgical candidates. That is a very small amount, and it is solely based off of symptoms.

Taylor Goldberg [00:29:58]:
And the main symptom to know if you are in that severe category is are you having cognitive changes that is different than brain fog? This is, you don't remember your name, you go to your friend's house and you don't know where you are. True cognitive changes, that is a red flag that we need to get looked at immediately. The rest, the dizziness, all of that stuff can improve when we improve our stability, when we improve our proprioception, when we create safety in our nervous system, when we create safety in our own body, when we're able to hold our neck up more, when we're able to get more blood flow to the brain, it can all improve, especially with upper cervical instability. And I really, really want people to.

Michelle Shapiro [00:30:40]:
Know that in addition to that hope, I will also tell you that not only can Taylor, you know, and any amazing practitioner that Taylor trains to be an amazing practitioner, help with that when it comes to at home. If you've listened to this podcast before, you know my approach on this, it's really about dizziness is a lot about being as non reactive to it as you possibly can. Because dizziness, if it is coming from blood flow issues, anxiety, something like that, dizziness will beget more dizziness if we do not become non reactive when it happens. So just as a language switch, when you're experiencing dizziness, and I know this is a big ask for me to ask people. However, I think again, in the past when I've had dizziness prior to me getting what I need to do from a limbic system perspective, I would immediately go into a fight or flight and be like, oh my God, why is this happening? This is so scary. This means something bad is happening. I want to go get an MRI. I want to go do this.

Michelle Shapiro [00:31:35]:
And everyone's welcome to get an MRI. Go to your neurologist anytime you need anything. Obviously. I think now when it happens, I'm like, I notice this weird symptom. Let me review what's been going on with me recently. And every single time I've ever had dizziness, it has always passed. And I know this is temporary. I know this will pass again.

Michelle Shapiro [00:31:56]:
And just give yourself that compassion in that moment instead of jumping into the what can I do to fix this right now? Jump into a little bit of acceptance, leaning into it, breathing into it. You can totally say, I hate this, and it sucks. It totally does suck. However, it is always temporary, and it will always be temporary. So you'll always make it through it. So just from a dizziness perspective, on that end, I had to mention that. So that's really important for people to know. There's things you can do physically.

Michelle Shapiro [00:32:23]:
Some of the tips Taylor's talking about to increase your proprioception. And now we're going to talk about the vision aspect specifically. It's really interesting. We have had the amazing Alyssa Chang on the podcast before who talks about how our visual system and our nervous system is very interconnected, too. Do you notice, Taylor, with clients with dizziness, that the vision will be more of a warning sign that dizziness is coming, like the vision changes, or because that's a little bit different than the dizziness, because they're also having the visual snow and different things happening? Or is it more you have progress, you have dizziness over a long period of time, and then you notice the vision issues. Tell me about what that pathology and what that process looks like for people.

What is the pathology and does the process look like for people experiencing vision changes and dizziness?

Taylor Goldberg [00:33:03]:
Yeah, so I usually see it as a warning sign. And let's talk a little bit about warning signs versus triggers. So, warning signs is something your body shows you and is saying, hey, we're going to be symptomatic soon if you don't do something. So when we get a warning sign and when we can learn our warning signs, blood pulling is also a good example of this. At your feet, and you see that your feet are super, super red, that's a warning sign. That's your body saying, hey, I'm not getting enough blood to my brain. Can we do something about this? We can be proactive in that situation. And so when it comes to vision, specifically as a warning sign, if you start noticing and most people really get triggered, which a trigger is something you do that, you know, brings on symptoms, and we're going to be reactive in those cases.

Taylor Goldberg [00:33:47]:
And a very common trigger for this population is driving or being in a car. That has a lot to do with our peripheral vision system, as well as our proprioception, as well as not feeling in control when we're in a car, as well as our positioning with our neck, and having brake strikes for a long period of time, and blood flow and vibrations and loud noises. There's a lot of reasons that driving can be a trigger. But one of the biggest warning signs that a lot of people experience, especially in cars, is they will get that visual snow, or they will get blurryish vision, feeling like you're in a cloud, like there's smoke in your eyes. That is a very common warning sign that, okay, I might be getting dizzy soon, and there can be very different reasons for that. But I would say in the car specifically, that is most likely from an overload that your visual system and peripheral vision specifically just can't handle at the moment. And we can train our visual system like anything else. We can do eye movements, if that is one of the parts of your puzzle piece, and that can help, as well as getting more blood back to our brain.

Taylor Goldberg [00:35:03]:
But the vision system is very interconnected with our nervous system. I mean, it's part of our nerves come from our brain. They go to our eyes, everywhere else in our body. Our brain conquers all. Everything we tell our brain, it remembers. Our brain controls everything. That doesn't mean things are in your head, but it does mean that we have to work on our head in order to feel better.

Michelle Shapiro [00:35:24]:
100%, yeah. When you say warning signs, I think what I've experienced myself, honestly, is it's, like, almost three step process. So if I'm doing something that's very physically exertive or I'm nodding a lot, which, wow, does that happen to my job? Because my face listening to people, like, and I'm nodding my head a lot, the first thing that happens is I'll get some, like, heat in the back of my head in that sub occipital lobe, like you were saying, and then I'll start to get a little, like, my eyes want to close kind of feeling, and then the dizziness starts coming on. That's common. I see that a lot in clients, too, and I also see it going different ways. Sometimes people notice the vision thing first, but feeling the heat down there, just also something that can help. I think that's just an at home something, is that. Taylor, you're a huge proponent of this, but icing your neck, so beautiful for the vagus nerve, in addition to literally just bringing some juicy blood flow there, cold, will cause more vasoconstriction.

Michelle Shapiro [00:36:20]:
So a big piece of dizziness is also histamines. Histamines end up being a huge piece of this dizziness puzzle. Can you tell us how histamines are related to dizziness also?

How are histamines related to dizziness?

Taylor Goldberg [00:36:32]:
Yeah. So histamine, in my opinion, is the mother of all the things, in my opinion. This is not backed by science talk about yet, but I have yet to see any of my clients not have some level of, quote, unquote mast cell issues, if you will. And so histamine. Mast cells produce more than just histamine. And I know you've talked thousands of mediators. Yeah, like so many mediators. Histamines.

Taylor Goldberg [00:37:01]:
Just the one that we talked about before. Most. But one of the mediators that it does produce is something called elastase, which basically, if you have too much elastase, your ligaments can become more lax. This can be very problematic in hypermobility, specifically, especially if that happens to be in your neck, and that makes things more unstable. Now we hit brainstem, now we're dizzy. That's a very oversimplified version. Another thing that can happen is our blood vessels themselves, selves are wrapped in connective tissue. They can become stretchy.

Taylor Goldberg [00:37:37]:
When our blood vessels become stretchy, that can lead to less venous return, less stroke volume, less cardiac output, and gravity becomes not our friend anymore. That's when we get that blood pooling, and that's when our heart is trying really, really hard. I need blood. I'm going to pump really, really, really fast. You get those heart palpitations. You're now feeling like you are being chased by a tiger. Your sympathetic nervous system is on high alert because it feels threatened, and symptoms come after that. And so if we can stop it at the warning sign of, oh, I see, my feet are really, really red.

Taylor Goldberg [00:38:14]:
I'm going to lay down with my legs above my heart, get some of that blood back to my brain, or I'm going to put compression on. Abdominal compression is better than compression socks, if possible, but I totally understand that since I can't, I personally can't handle the abdominal compression, so I get it. But if we lived in a perfect world where we didn't have any weird sensitivities, that would be ideal. But these are really easy things that anybody can do at home. And so if you look down at your feet and you see they're really, really red, lay down, legs up, five to ten minutes, maybe hum to your favorite song. Do something for your vagus nerve. Put ice on your chest. Gargling water can be helpful for this as well.

Taylor Goldberg [00:38:54]:
All this stuff is free as well, which I love. I think that we have commercialized the vagus nerve way too much. In my opinion, a lot of the stuff that we can do for the Vegas nerve is free. Laughing helps the vagus nerve. Like I said, singing, humming, that's a tangent. But compression and music, yeah, or ice free, literally.

Michelle Shapiro [00:39:16]:
So when it comes to histamine, specifically elastases, these mediators from our mast cells histamines induce something called vasodilation, which I'm sure if you've heard me talk about anything, you've heard that word come out of my mouth at some point. But basically what they'll do is widen our blood vessels so that it's for a robust immune response, so that our body can get nutrients, immune cells, everything it needs to a site of injury, essentially. So the result of that ends up being when we have constant histamine activation, constant mast cell activation that results in histamine output, is that we have constant vasodilation. That's actually what can lead to those leaky blood vessels, and that's what can actually lead to all that blood pooling, because if our blood vessels are wide open, they're not pumping, and we need that vasoconstriction to make blood pump, which, as we've talked about, can be a problem when it comes to really, like, two types of these dizziness, which is if you're not getting good cerebral blood flow, that's one cause. Also, if you're not getting blood flow to your occipital lobe, which then is going to influence your vision, that's another cause. And if you're not getting blood flow to your heart, actually, just, um, your heart pumping really quickly can also be dizzying to your body as well. Do you know the mechanism behind that? Or is because I know that feeling. Um, and it's not only from the lack of cerebral blood flow, it's also when your heart rate's high, you get dizzy too.

Taylor Goldberg [00:40:37]:
I I think it's this, the same idea. It's that, that the heart rate is actually, the beating heart rate is a warning sign, if you will, telling your body that you're not getting enough blood. But also our blood volume and our adrenaline chemicals are, like, opposite. So if our blood volume is low, our adrenaline chemicals are high. So neuropinephrine and epinephinephrine, which I can never pronounce, they're opposite. And that if our adrenaline chemicals are really, really high, that can also make us feel busy, that can also make us feel out of control. So that's definitely part of the picture here as well.

Michelle Shapiro [00:41:10]:
Yeah, let's talk about, like, the case of, like, someone who's having really high cortisol hyper adrenergic pots, and that experience of dizziness, which is like, even, it's like a zingy dizziness. But certainly adrenaline and those other stress hormones can, and neurotransmitters can make us feel dizzied. As well. Are you believing, and this is a little bit speculative of just going through the mechanisms, but do you believe that that comes from those hormones themselves and the effects that they have, or it's literally because they're causing the changes in blood flow and heart rate?

What is the cause of dizziness for someone who has high cortisol hyper adrenergic pots?

Taylor Goldberg [00:41:45]:
Chicken or egg? I don't know that I can answer that. I think it's chicken versus egg. But on this topic, let's talk about the different types of pots, because I don't think it's talked about enough. So there's three different types of pots. Neuropathic hyper angenergic, which is really hard to say, and hypovolemic hyper angle is not that uncommon, in my opinion. I've seen way more than I expected to see, and I think that it is on social media, not talk about a lot or you'll never see that type, so don't worry about it. And it does drastically change our treatment methods because we can no longer use salt in this specific population. So for the hyper angenergic type, they actually have high blood pressure, which salt can make that worse.

Taylor Goldberg [00:42:32]:
And so we have to find other ways to figure out how to help this population. This population usually also isn't from not lacking blood flow, and to the brain, it is the opposite, and they might have too much of something. This is where we can see intracranial hypertension more commonly as well, which can be another cause of dizziness, another cause of visual snow and those weird visual symptoms.

Michelle Shapiro [00:42:58]:
I have to add to how important what you're saying is here. You could have the same symptoms from high blood pressure and low blood pressure.

Taylor Goldberg [00:43:05]:
Yes, exactly.

Michelle Shapiro [00:43:06]:
And in the brain, too. So that's. That's what's complicated about it. The one thing I want to add about hyper adrenergic pots, though, is that oftentimes people will have high blood pressure or high heart rate, and there actually is a trigger of low blood pressure and low heart rate, and they're not realizing it, too. So the salt is, like, more selective timing wise, because when it comes to your adrenal adrenaline at all, when it comes to your adrenal glands, we do actually require more salt in times of stress. So you need to replenish it, but you can't do it when your blood pressure is already high. So it's a really interesting and fascinating piece of this in something like hyper adrenergic pots, because you're also having potential symptoms from low blood pressure, high blood pressure, and it can vacillate. So you really have to.

Michelle Shapiro [00:43:50]:
That's when you really have to actually have blood pressure crop and actually know when it's your time to compress, when it's your time to get that cerebral blood flow, and when it's time to actually do the opposite.

Taylor Goldberg [00:44:00]:
Yeah. And there's actually a really cool device coming out. I think it's still like a year out. It's. It's not anytime soon, but it's called stat, and it's a little thing you put in your ear, and it will tell you when you need more blood to your brain. And it, the research they've done so far looks so, so promising. And I think for specifically hyperandrenergic pots, this is going to be a complete game changer. I think it's a game changer for everybody, but specifically that group of people, I think this is really going to benefit them.

Taylor Goldberg [00:44:32]:
And I am so, so excited for that to come out. And if anybody wants to be like a test trial, they are running trial.

Michelle Shapiro [00:44:40]:
Periods right now, so 100%. And I think, again, so it's really interesting, because in hypovolemic pots, you're having low blood volume, right? So you're. You're having that inability to get that blood flow to the brain. It's really like dizziness comes down to what we're kind of, if we're looking back on our conversation and I'm reflecting on it as we're talking, it comes down to, where's the blood flow? Where's the nervous system acting? Where does your body know where it is? Essentially, it's like those are kind of those components of it. So for some people with dizziness, honestly, salt can be salt and compression. The reason that these are recommended for pots is the same reason they'd be recommended for dizziness in many people, but not everyone, as we said, they can help with that blood flow. Taylor, before you mentioned abdominal binders, I'm going to tell you, because this is not a thing that I knew about before either, but it's basically like, it looks like an ace bandage, essentially, and you wrap it around your waist. And the very simply, it helps to push blood flow back into your heart if your body's having a hard time getting that, like you said, venus return and that blood flow back to the heart.

Michelle Shapiro [00:45:47]:
Same thing with compression socks. If you see, you know, me and Taylor in our, mine are like granny compression socks. Taylor's are like cute compression socks, but.

Taylor Goldberg [00:45:54]:
If you see that flowers.

Michelle Shapiro [00:45:56]:
Yeah, exactly. Yours have, like, adorable flowers. But the goal is to create juicy blood flow, that it's a symptom manager. It's not fixing the problem, which is the problem is that your nervous system is telling the wrong parts of your body where to send blood flow. That's more of the thing that's happening, or you don't have enough blood volume, or your body's responding with stress or whatever it is. But in total, what you're really wanting to do is find out, what are my specific triggers for dizziness? What are the pathways that are making the dizziness happen in the first place? And then you'll know, based on all of the tools we just talked about, little things you can try, because there's days where my dizziness might be coming from the back of my head, and some days they might be coming from me standing up. It can be all different triggers and reasons. It's really about finding out and knowing that there are so many specific reasons why dizziness happens.

Michelle Shapiro [00:46:47]:
And this also kind of is similar to why headaches happen. And some of the kind of common triggers of why headaches happen are actually very similar to why dizziness happens. The different ways to kind of look at or start a dizziness journey are to think about, like Taylor said, those three questions you would be asking yourself if you're working with a practitioner, making sure they're asking you those right questions. If you're identifying it as vertigo, it's a completely different treatment plan than if you're identifying it as dizziness and then thinking about also, is this more of an issue with blood flow? Is this more of an issue with something going on in the back of my head? Is this more of an issue with upper cervical instability? And that's how you can move from there. But the most important thing of all, when it comes to dizziness is understanding that your symptoms are not random. It's your body trying to communicate something with you. And there's almost always something that you can do to either make the symptoms better work at the root cause, or to experience them as less scary. And I think that's what's really important, too, is that the actual coming with non reactivity.

Michelle Shapiro [00:47:54]:
Oh, my goodness, is this hard? Can actually be one of the most profound, supportive tactics for dizziness overall.

Taylor Goldberg [00:48:00]:
Yeah. And I just want to reiterate that we are only talking about a very small group of the many things that go on in the dizziness realm. But for the hypermobile population specifically, or anybody with a connective tissue disorder, these are the most common things that we experience. There are a whole slur of other things, especially in the vestibular world, that peripheral type of vertigo. So if this is like. I'm not really relating. I don't know if I fall into this. You might be in a different camp of dizziness, and I highly recommend looking into the vertigo.

Taylor Goldberg [00:48:34]:
Doctor, she's amazing.

Michelle Shapiro [00:48:35]:
Yeah. Thank you so much, Taylor. This was exactly what people need. I really want people to just hit home with the fact that dizziness is not this random big blob of a thing that is unfixable, that is untouchable. There are so many things we can do. And because we gave so many different pathways and different pieces of information, I'm going to leave us with that. Thank you for coming, Taylor. You're the best.

Taylor Goldberg [00:48:57]:
Thanks for having me.